目的评价纤维支气管镜（FOB）与直接喉镜（DLS）经鼻引导气管插管对患者血流动力学反应的影响。方法计算机配合手工检索了截止到2014年12月,在Pubmed,Cochrane Library,Web of Science,中国知识基础设施工程（CNKI）,维普数据库（VIP）...目的评价纤维支气管镜（FOB）与直接喉镜（DLS）经鼻引导气管插管对患者血流动力学反应的影响。方法计算机配合手工检索了截止到2014年12月,在Pubmed,Cochrane Library,Web of Science,中国知识基础设施工程（CNKI）,维普数据库（VIP）,万方数据库中关于FOB与DLS经鼻引导气管插管对血流动力学反应影响的随机对照研究（RCT）文献,筛选后进行质量评价并提取数据,采用RevMan 5.3软件进行Meta分析。结果最终共纳入8篇文献,462例患者。FOB组患者的收缩压（SBP）在插管后3min,5min时明显高于DLS组,差异均有统计学意义[（WMD=3.64,95%CI为1.37~5.91）,（WMD=3.39,95%CI为1.63~5.15）,P〈0.05];FOB组和DLS组患者的舒张压（DBP）在所有测量时间点的差异均无统计学意义;FOB组患者的心率（HR）在气管插管时明显高于DLS组,差异有统计学意义（WMD=9.09,95%CI为5.05~13.14,P=0.00）;FOB组患者的平均动脉压（MAP）在气管插管时明显高于DLS组,差异有统计学意义（WMD=10.60,95%CI为5.89~15.30,P=0.00）。FOB组患者的气管插管时间明显长于DLS组,差异有统计学意义（WMD=9.20,95%CI为5.19~13.21,P=0.00）。结论 DLS经鼻引导气管插管对患者血流动力学反应影响小,较FOB有优势。展开更多
目的研究接受全身麻醉甲状腺手术的患者使用光导纤维支气管镜(fiberoptic bronchoscope,FOB)和GlideScope视频喉镜(GlideScope video laryngo-scope,GSVL)经口气管插管的血流动力学反应及其并发症。方法拟行经口气管插管全身麻醉甲状腺...目的研究接受全身麻醉甲状腺手术的患者使用光导纤维支气管镜(fiberoptic bronchoscope,FOB)和GlideScope视频喉镜(GlideScope video laryngo-scope,GSVL)经口气管插管的血流动力学反应及其并发症。方法拟行经口气管插管全身麻醉甲状腺手术患者80例,美国麻醉医师协会Ⅰ~Ⅲ级,年龄23~70岁,随机分为FOB组和GSVL组,每组40例。常规麻醉诱导后,分别采用FOB或者GSVL实施经口气管插管,记录麻醉诱导前(基础值)、气管插管前、气管插管即刻以及气管插管后1、2、3、5、10 min时的血压和心率。观察患者气管插管的血流动力学变化及其并发症。结果 2组患者血流动力学指标变化差异无统计学意义,但与GSVL组相比,FOB组患者气管插管1次成功率高、插管时间短、术后并发症发生率低。结论 FOB与GSVL均可减轻气管插管的血流动力学反应。与GSVL相比,FOB在提高气管插管成功率及减少其相关并发症方面具有优势。展开更多
AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwe...AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009("pre-VL" group) and over the same 2-mo period after the introduction of VLs in 2012("postVL" group). Patient records with predicted difficult air-ways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.RESULTS To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually(P = 0.1768), it showed a trend toward significance when covariates were accounted for(P = 0.0910). Several factors predicting a higherlikelihood of awake FOI were found to be statistically significant: Morbid obesity(larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender(P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score(P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.CONCLUSION Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.展开更多
基金Department of Anesthesiology at Rush University Medical Center for support
文摘AIM To determine if video laryngoscopy(VL) has significantly impacted management of difficult airways by decreasing the rate of awake fiberoptic intubation(FOI). METHODS Anesthetic records of 3723 patients who underwent general anesthesia at Rush University Medical Center were reviewed over a 2-mo period prior to the introduction of VLs in 2009("pre-VL" group) and over the same 2-mo period after the introduction of VLs in 2012("postVL" group). Patient records with predicted difficult air-ways based on pre-operative airway examination were analyzed. The primary outcome was rate of awake FOI.RESULTS To control for possible factors that may influence the FOI rate, a logistic regression was performed with these factors included as covariates. The rate of awake FOI was 13.1% in pre-VL group compared to 9.0% in post-VL group. Although this decrease was not statistically significant individually(P = 0.1768), it showed a trend toward significance when covariates were accounted for(P = 0.0910). Several factors predicting a higherlikelihood of awake FOI were found to be statistically significant: Morbid obesity(larger BMI P = 0.0154, OR = 1.5 per 10 point BMI increase), male gender(P = 0.0026, OR = 3.0) and a higher el-Ganzouri airway score(P = 0.0007, OR = 1.5). Although VLs were seen to be used to intubate 51% of predicted difficult airways, the rate of awake FOI has not significantly changed.CONCLUSION Although VL may continue to grow in popularity, the most difficult airways are still managed using awake FOI.
